Zantac Qualification Client Questionnaire

This is our Zantac Qualification Client Questionnaire. and thank you for taking the time to fill it out. This form is designed to gather important information about your Zantac usage, medical history, and the impact of your diagnosis. Your responses will help us determine if you qualify for a lawsuit and how we can best assist you in seeking compensation for your suffering.

Please follow these instructions carefully to ensure that we have all the necessary information to evaluate your case:

  1. Personal Information: Provide your full name, date of birth, contact details, and address. This information is crucial for our records and to get in touch with you regarding your case.
  2. Zantac Usage Information: Indicate how long you have used Zantac, the form of Zantac (prescription, over-the-counter, or both), the dosage, and the frequency of your use. Accurate details about your Zantac consumption will help us understand your exposure to the drug.
  3. Medical Information: Select all types of cancer you have been diagnosed with and provide the date of diagnosis. Additionally, check the treatments you have received and give a brief description of your medical history and Zantac use. This section is essential for linking your health condition to Zantac usage.
  4. Legal Information: Let us know if you have previously filed a lawsuit related to Zantac or if you currently have an attorney representing you. If applicable, provide details about your attorney and any ongoing legal actions.
  5. Additional Information: Tell us how you heard about our services and share any comments or questions you may have. Your feedback helps us improve our services and address any concerns you might have.
  6. Consent and Submission: Read the consent statement carefully. By agreeing, you acknowledge that you understand the terms and privacy policy and that submitting this form does not create an attorney-client relationship. Once you have completed all sections, click the submit button to send your information to our legal team.

Confidentiality Notice: Your privacy is our top priority. All information submitted through this form will be kept confidential and used solely for the purpose of evaluating your Zantac lawsuit case. We do not share your personal information with third parties without your explicit consent.



Lee Davis is here to help if you have any questions regarding this Zantac Qualification Client Questionnaire at 412-781-0525 for a confidential consultation and take the first step towards reclaiming your future.